CPT Code 26499 | Description & Clinical Information
CPT 26499 describes a medical procedure where the provider treats claw finger, a curved finger deformity, by repositioning the flexor tendon from the palm side to the side of the finger, allowing it to function as an extensor tendon, and this method is not represented by any other specific code.
Official Description
The CPT book defines CPT code 26499 as: “Correction claw finger, other methods”.
Clinical Information
The procedure described by CPT code 26499 is a surgical method that corrects claw finger deformation, where the fingers are bent unnaturally due to muscle and tendon imbalance. This procedure is performed by healthcare providers through a series of steps that involve making incisions and dissecting the soft tissues to expose the flexor and extensor tendons.
The entire process begins with the appropriate preparation of the patient and providing anesthesia. Once the patient is prepped, the provider makes an incision on the side of the middle finger and extends it to expose the flexor tendon. Using a blunt hook, the provider pulls the tendon out while flexing the middle finger. With the aid of a scalpel or sharp object, the provider then frees the tendon from surrounding soft tissues. This is to facilitate free movement of the tendon and prepare it for further use.
Next, the provider creates a longitudinal incision on the palm near the wrist. This incision is used to locate the extensor tendon and identify the tendon previously freed by incision of the middle finger. The provider then pulls the tendon strip, detaching it from the phalanx of the middle finger, and splits it into four sections.
Moving on, the provider creates an incision on the side of the index finger and inserts an instrument called a tunneler through it. The tunneler has forceps attached to it, which the provider uses to advance the instrument through the lumbrical canal, a gap between the soft tissues present between the thumb and index finger area. The provider pulls the first slip section, which is on the thumb side, and brings it out through the index finger incision. The provider then attaches the slip section to the proximal phalanx on the thumb side of the finger using sutures. This new attachment site, from the palm side to the side of the proximal phalanx, corrects the deformity by extending the joint between the metacarpal and proximal phalanx.
The same procedure is repeated for the other three fingers to correct the deformity further. The provider may also attach the slips to tendon pulleys, which are ligament rings around the tendons, to release the tension on the tendon. Once the surgery is completed, the provider closes the operative sites in layers and immobilizes the wrist with a splint.
In conclusion, CPT code 26499 describes a surgical method that corrects claw finger deformities. The procedure involves making incisions and dissecting the soft tissues to expose the flexor and extensor tendons, followed by splitting the tendon strip into four sections, attaching them to the phalanx of the finger, and correcting the deformity. This procedure is commonly used when no other more specific code can describe the method used, and it effectively improves the range of motion in fingers with claw finger deformity.
